psyg-11-565638 Janua y 18, 2021 Time: 17:36 # 1
BRIEF RESEARCH REPORT
published: 22 Janua y 2021
doi: 10.3389/ psyg.2020.565638
Edi ed by:
Lau i A. Jensen-Campbell,
Uni e si y o Texas a A ling on,
Uni ed S a es
Re iewed by:
Belen Lopez-Pe ez,
Li e pool Hope Uni e si y,
Uni ed Kingdom
Ma ía C is ina Richaud,
Consejo Nacional de In es igaciones
Cien í icas y Técnicas (CONICET),
A gen ina
*Co espondence:
Sonsoles Valdi ia-Salas
sonso al@uniza .es
Special y sec ion:
This a icle was submi ed o
Pe sonali y and Social Psychology,
a sec ion o he jou nal
F on ie s in Psychology
Recei ed: 25 May 2020
Accep ed: 15 Decembe 2020
Published: 22 Janua y 2021
Ci a ion:
Valdi ia-Salas S, Ma ín-Albo J,
C uz A, Villanue a-Blasco VJ and
Jiménez TI (2021) Psychological
Flexibili y Wi h P ejudices Inc eases
Empa hy and Dec eases Dis ess
Among Adolescen s: A Spanish
Valida ion o he Accep ance
and Ac ion Ques ionnai e–S igma.
F on . Psychol. 11:565638.
doi: 10.3389/ psyg.2020.565638
Psychological Flexibili y Wi h
P ejudices Inc eases Empa hy and
Dec eases Dis ess Among
Adolescen s: A Spanish Valida ion o
he Accep ance and Ac ion
Ques ionnai e–S igma
Sonsoles Valdi ia-Salas1*, José Ma ín-Albo1, A aceli C uz1, Víc o J. Villanue a-Blasco2
and Te esa I. Jiménez1
1Depa men o Psychology and Sociology, Uni e si y o Za agoza, Te uel, Spain, 2Depa men o Psychology, Valencian
In e na ional Uni e si y, Valencia, Spain
Empa hy is an emo ional esponse ha may acili a e p osocial beha io and inhibi
agg ession by inc easing empa hic conce n o o he s. Bu he ica ious expe ience
o o he ’s eelings may also u n in o pe sonal dis ess when he pe son has poo
egula ion skills and holds s igma izing belie s. In hinking abou he p ocesses ha
may igge he expe ience o pe sonal dis ess o empa hic conce n, esea ch on
he in luence o psychological lexibili y and in lexibili y on s igma is showing p omising
esul s. Bo h p ocesses a e assessed wi h he Accep ance and Ac ion Ques ionnai e–
S igma (AAQ-S). The cu en s udy sough o ca y ou a alidi y s udy o a Spanish
e sion o he AAQ-S wi h a sample o adolescen s aged 11–17 yea s. The s udy
included an expanded es o i s p edic i e alidi y wi h measu es a h ee imes o
e alua e he ole o psychological lexibili y and in lexibili y as isk o p o ec i e a iables
o he de elopmen o pe sonal dis ess and/o empa hic conce n in he s igma ize .
S a is ical analyses con i med a wo-co ela ed- ac o solu ion, he adequa e eliabili y
o bo h ac o s, and hei cons uc and p edic i e alidi y in he expec ed di ec ion. The
s igma ize ’s in lexible eac ion o hei s igma izing hough s p edic ed he occu ence
o pe sonal dis ess, whe eas he s igma ize ’s lexible eac ion o hei s igma izing
hough s p edic ed he occu ence o empa hic conce n o o he s. These indings
con i m he impo ance o conside ing he ole o egula o y skills in he expe ience
o empa hic conce n o pe sonal dis ess in he p esence o s igma izing hough s,
wi h possible implica ions o he p omo ion o p osocial beha io and he educ ion
o agg essi e beha io among adolescen s.
Keywo ds: psychological in lexibili y, psychological lexibili y, s igma, empa hic conce n, pe sonal dis ess,
Spanish adolescen s
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Valdi ia-Salas e al. S igma izing Though s, Empa hy, and Dis ess
INTRODUCTION
I is gene ally assumed ha empa hy is an emo ional esponse
ha may acili a e p osocial beha io and inhibi agg ession, hus
leading o a be e pe sonal and social adjus men om childhood
(e.g., S a inides e al., 2010;Wang e al., 2011;Mikolajewski e al.,
2014;Ca lo e al., 2015;Telle and P is e , 2016;Deschamps e al.,
2018;Tampke e al., 2020). The lack o consensus on he bene i s
o empa hy (e.g., Vachon e al., 2014), howe e , has p omo ed
he eme gence o nume ous models and heo ies abou wha
empa hy is and i s ela ion wi h o he cons uc s and ou comes
( o a e iew, see Cu e al., 2014).
The mul idimensional model o empa hy by Da is (1983), o
ins ance, dis inguishes be ween cogni i e and a ec i e empa hy.
Cogni i e empa hy is he abili y o unde s and how o he s
eel, whe eas a ec i e empa hy en ails he ica ious expe ience
o o he s’ eelings (Vachon and Lynam, 2016). As no ed by
Eisenbe g e al. (2010), i abo e some minimal h eshold, such
ica ious expe ience o o he ’s eelings may u n in o empa hic
conce n (EmpCon), pe sonal dis ess (Pe D), o bo h (see
also Habashi e al., 2016). While EmpCon consis s o eelings
o so ow o conce n o he o he , Pe D is a sel - ocused,
a e si e–a ec i e eac ion o ano he ’s emo ion associa ed wi h
he desi e o alle ia e one’s own, bu no he o he ’s dis ess.
Acco dingly, EmpCon ends o be posi i ely ela ed o helping
o he s, whe eas Pe D ends o be nega i ely o un ela ed o
p osocial beha io s (e.g., G aziano and Habashi, 2010;Habashi
e al., 2016;Win e e al., 2017), also in adolescen s (Eisenbe g
e al., 2010), and in Spanish adolescen s (Gu ié ez e al., 2011;
Tu -Po ca e al., 2016;Valdi ia-Salas e al., 2021).
In hinking abou he p ocesses by which he ica ious
expe ience o o he ’s eelings may e ol e in o ei he EmpCon
o Pe D, he men al lexibili y and sel - egula ion componen o
empa hy (Dece y and Jackson, 2004) may shed some ligh . This
componen allows inhibi ing one’s own pe spec i e and engaging
in pe spec i e aking so as o e alua e he o he s’ poin o iew.
These egula ion skills p e en ica ious emo ional hype a ousal
om u ning in o Pe D (Eisenbe g, 2000; see also Valdi ia-Salas
e al., 2009;Ikezawa e al., 2012;Habashi e al., 2016;G ynbe g
and López-Pé ez, 2018).
The Pe D expe ienced wi hin in e pe sonal domains may
also esul om holding s igma izing belie s abou o he s
(Masuda e al., 2009). S igma is he endency o e alua e and
disc imina e agains o he s based on hei g oup membe ship
(Le in e al., 2014). S igma izing hough s a e usually ega ded
as igid and sel -p o ec i e because hey acili a e he a oidance
o pe cei ed dange (Masuda e al., 2007; see also Kokkinos
and Kip i si, 2018). While he e is ex ensi e e idence o he
ha m ul consequences o s igma o he s igma ized g oup ( o
a e iew, see K a e al., 2018), esea ch conduc ed on he causes
and consequences o s igma o he s igma ize is a he sca ce
(Masuda e al., 2009). One line o such esea ch sugges s ha
psychological in lexibili y (PsyIn lex) may pose a isk o he
de elopmen o Pe D in he s igma ize , which, in u n, may lead
o he s igma iza ion o o he s (Masuda e al., 2009).
PsyIn lex occu s when ac ions a e igidly guided by
psychological eac ions (e.g., pe cei ed dange , nega i e
a ec , s igma izing hough s), a he han chosen alues, and a e
p ima ily aimed a down- egula ing such psychological eac ions
(e.g., Hayes e al., 1996;Tö neke e al., 2008;Valdi ia-Salas
e al., 2010). PsyIn lex is associa ed wi h a b oad ange o
psychological and beha io al heal h p oblems, Pe D among
o he s (Mones ès e al., 2018). On he con a y, i s coun e pa
psychological lexibili y (PsyFlex) e e s o he p ocess o
engaging wi h psychological eac ions wi hou ying o down-
egula e hem, while ac ing in alued di ec ions, and has
been ela ed o heal h and quali y o li e and li e sa is ac ion
(Mones ès e al., 2018).
The empi ical e idence on he ela ion be ween PsyIn lex and
s igma is sca ce bu shows consis en esul s. The de elopmen
and alida ion o he ques ionnai e o assess PsyIn lex and
PsyFlex wi h p ejudice hough s, i.e., Accep ance and Ac ion
Ques ionnai e–S igma (AAQ-S; Le in e al., 2014), we e
conduc ed wi h unde g adua e s uden s in a c oss-sec ional s udy
and showed con e gen alidi y wi h e hnocul u al empa hy,
EmpCon, and pe spec i e aking. A la e s udy e ealed ha he
combina ion o high PsyIn lex, low PsyFlex, low EmpCon, and
low pe spec i e aking accoun ed o app oxima ely 36% o he
a iance in gene alized p ejudice and ha he combina ion o
PsyIn lex and PsyFlex alone p edic ed gene alized p ejudice o e
igh wing au ho i a ianism and social dominance (Le in e al.,
2016). A ecen e iew and me a-analysis (K a e al., 2018) has
e ealed signi ican co ela ions be ween PsyIn lex and di e en
ypes o s igma, wi h an o e all e ec size s a is ically signi ican
and medium o la ge (see also Masuda e al., 2009).
All s udies on he ela ion be ween PsyIn lex and s igma
ha e been conduc ed wi h No h Ame ican adul s, and hei
c oss-sec ional na u e does no allow concluding abou he
mechanisms explaining his ela ion o he di ec ion o he
ela ions obse ed. In Spain, s igma has been explo ed p ima ily
owa d he men ally ill (e.g., Cangas e al., 2017), and only
ecen ly, he e is a g owing in e es in explo ing he po en ial
o PsyIn lex and PsyFlex wi h p ejudice hough s o he
unde s anding o youngs e s’ s igma owa d he men ally ill
(T igue os e al., 2020). The e is also e idence ha gene al
PsyIn lex in luences nega i ely Spanish child en and adolescen s’
psychological well-being (Valdi ia-Salas e al., 2017;Ga cía-
Gómez e al., 2019;Mes e e al., 2019;Ga cía-Rubio e al., 2020).
Bu he ela ion among PsyFlex, PsyIn lex, Pe D, and EmpCon
emains unexplo ed. In his di ec ion, he cu en s udy sough
o ca y ou a alidi y s udy o a Spanish e sion o he AAQ-S
wi h a sample o adolescen s aged 11–17 yea s. The s udy includes
an expanded es o i s p edic i e alidi y wi h measu es a h ee
imes o e alua e he ole o PsyIn lex and PsyFlex as isk o
p o ec i e a iables o he de elopmen o Pe D and EmpCon
in he s igma ize .
METHODS
Pa icipan s
We employed andomized clus e sampling o selec pa icipan s.
The uni (clus e ) was he school. The sampling ame was all he
public schools in he a ge egion. Each school on he lis was
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Valdi ia-Salas e al. S igma izing Though s, Empa hy, and Dis ess
assigned a weigh equi alen o he numbe o s uden s a ending
he school. Fou schools we e selec ed, and he p incipals o
all o hem ag eed o pa icipa e. S uden s wi h ages anging
be ween 11 and 17 yea s (mean = 13.66, SD = 1.34) and a ending
he ou compulso y seconda y educa ion cou ses illed ou he
ques ionnai es h ee imes wi hin a 12 mon hs in e al. The
numbe o pa icipan s on each ime was as ollows: 847 (410
boys, 435 gi ls) a Time 1, 568 (271 boys, 297 gi ls) a Time 2,
and 275 (131 boys, 144 gi ls) a Time 3.
Measu es and Ins umen s
PsyIn lex and PsyFlex Wi h P ejudice Though s
We employed an ad hoc Spanish ansla ion o he AAQ-S
(Le in e al., 2014). I includes 21 i ems ha measu e PsyFlex
(“I am awa e when judgmen s abou o he s a e passing h ough
my mind,” “When I e alua e someone nega i ely, I am able o
ecognize ha his is jus a eac ion, no an objec i e ac ”) and
PsyIn lex (“My biases and p ejudices a ec how I in e ac wi h
people om di e en backg ounds,” “When I ha e judgmen s
abou o he s, hey a e e y in ense”) wi h a b oad ange o
nega i e hough s abou people belonging o di e en s igma ized
g oups. Response op ions ange om 1 (ne e ue) o 7 (always
ue), so ha highe sco es in he PsyIn lex subscale indica e
g ea e in lexibili y, and highe sco es in he PsyFlex subscale
indica e g ea e lexibili y. We ansla ed he ins umen in o
Spanish wi h he pa allel back- ansla ion p ocedu e (B islin,
1986). The i ems we e i s ansla ed om English in o Spanish
by expe ansla o s. The i ems we e hen back- ansla ed in o
English and compa ed wi h he o iginal ones. Finally, h ee
expe s and i e s uden s e alua ed he adequacy o he i ems o
he cons uc being assessed. We ound no majo di icul ies wi h
he seman ic equi alence o he i ems in Spanish.
Psychological In lexibili y
We employed he Spanish alida ion (Valdi ia-Salas e al., 2017)
o he A oidance and Fusion Ques ionnai e o You h (AFQ-Y;
G eco e al., 2008). The AFQ-Y con ains 17 i ems, measu ing
wo in e ela ed p ocesses ha cha ac e ize PI, namely, cogni i e
usion (CF; e.g., “My hough s and eelings mess up my li e”)
and expe ien ial a oidance (EA; e.g., “I s op doing hings ha a e
impo an o me whene e I eel bad”), and esponden s a e how
ue each s a emen is o hem on a 5-poin scale anging om
0 (no a all ue) o 4 ( e y ue). Highe sco es indica e g ea e
CF and EA. The Spanish alida ion showed good psychome ic
p ope ies wi h Spanish adolescen s (Valdi ia-Salas e al., 2017).
Empa hy
We employed he Spanish alida ion (Pé ez-Albéniz e al., 2003)
o he In e pe sonal Reac i i y Index (IRI; Da is, 1980). The IRI is
a 28-i em sel - epo ques ionnai e ha comp ised ou subscales,
namely, Fan asy, Pe spec i e Taking, EmpCon, and Pe D (se en
i ems each). We employed only he EmpCon and Pe D subscales
because o he li e a u e ha poses hem as a iables in ol ed
in ei he p osocial o agg essi e beha io (Cu e al., 2014). The
EmpCon e lec s he a ec i e/emo ional componen o empa hy
and assesses he endency o expe ience wa m h, conce n, and
compassion o o he s (e.g., “I o en ha e ende , conce ned
eelings o people less o una e han me,” “I would desc ibe
mysel as a p e y so -hea ed pe son”). The Pe D subscale
assesses eelings o discom o and anxie y ha people may
expe ience when hey wi ness nega i e expe iences in o he s (e.g.,
“I eel helpless when I am in an emo ionally cha ged si ua ion,
“I sca es me o be in a ense emo ional si ua ion”). Responde s
a e each i em on a scale anging om 0 (no a all like me) o 4
( e y much like me), and i ems a e summed so ha highe sco es
e lec g ea e EmpCon and g ea e Pe D. The e is e idence o he
good psychome ic p ope ies o hese wo subscales in Spanish
adolescen s (Ca asco O iz e al., 2011).
P ocedu e
We con ac ed he p incipals o he a ge schools o explain
he pu pose o he esea ch and o eques hei pe mission o
ca y ou he s udy. A e we had ob ained pe mission om
he school p incipals, we eques ed he pa en s’/ u o s’ consen
o hei child en o pa icipa e in he s udy. Once in he
class oom, he esea che s desc ibed he goals o he s udy and
in o med he s uden s ha hei pa icipa ion was olun a y and
con iden ial and ha he e we e no good o bad answe s. A
leas one esea che was p esen du ing he adminis a ion o he
ins umen s o p o ide s uden s wi h he necessa y suppo o
success ully comple e he ins umen s.
Da a Analysis
We i s calcula ed he desc ip i e s a is ics (mean, SD, and
co ela ions) o he AAQ-S i ems and hei mean di e ences as
a unc ion o gende by using he s a is ical package SPSS o
Windows e sion 22 (IBM Co p, 2013).
The ac o ial s uc u e o he scale was analyzed wi h he
weigh ed leas squa es mean and a iance adjus ed es ima ion
o 6.1 Mplus (Mu hén and Mu hén, (1998-2010)). The ac
ha class oom was ou sample uni iola ed he assump ion o
independence o obse a ions. This migh ha e in la ed he χ2
alue and unde es ima ed s anda d e o s (S aple on, 2006). Fo
his eason, he “clus e ” op ion o class ooms and COMPLEX
unc ion we e used in all analyses. We used C onbach α o es he
eliabili y o he AAQ-S and he esul s o he con i ma o y ac o
analysis (CFA) o calcula e he composi e eliabili y index (CRI).
In o de o es o he cons uc alidi y o he AAQ-
S, we conduc ed a new CFA model inco po a ing he wo
ac o s o he AFQ-Y. In o de o es ablish he AAQ-S
p edic i e alidi y, we es ed he model shown in Figu e 1
wi h longi udinal pa h analysis me hodology and he maximum-
likelihood obus es ima ion.
The ollowing goodness-o - i indices we e epo ed: χ2 o
model i , oo mean squa e e o o app oxima ion (RMSEA),
compa a i e i index (CFI), and Tucke –Lewis Index (TLI).
Following B owne and Cudeck (1993) indica ions, RMSEA
alues close o 0.05, close o 0.08, and highe han 0.10 indica e
good, easonable, and bad i , espec i ely. CFI alues should
be highe han 0.90 (Ma sh e al., 2004). TLI alues be ween
0.90 and 0.95 a e conside ed accep able. Finally, missing da a
we e eplaced by he me hod o linea in e pola ion usually
employed by Mplus.
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Valdi ia-Salas e al. S igma izing Though s, Empa hy, and Dis ess
FIGURE 1 | Longi udinal pa h.
RESULTS
Desc ip i e Analyses
As Table 1 shows, mean PsyIn lex sco es (i ems 1, 4, 6, 7, 8, 9,
13, 15, 16, 20, 21) we e, o e all, lowe han mean PsyFlex sco es
(i ems 2, 3, 5, 10, 11, 12, 14, 17, 18, 19). All PsyIn lex i ems sco ed
lowe han 2.5, whe eas all PsyFlex i ems, excep o i ems 12
and 18, sco ed highe han 2.5. As o he co ela ions, hey we e
s ong among same ac o i ems, wi h some excep ions: i em 4
co ela ed posi i ely wi h i em 5 ( xy = 0.37; p<0.05) and i em 19
( xy = 0.27; p<0.05); as well, i em 16 co ela ed posi i ely wi h
i em 17 ( xy = 0.32; p<0.05). Ku osis and asymme y indices
we e lowe han 2, which p o e uni a ia e no mali y.
Con i ma o y Fac o Analysis and
Reliabili y
Following he o iginal s uc u e, we es ed he wo-co ela ed-
ac o solu ion, which showed good i indices in he o al sample
[χ2= 500.36, deg ees o eedom (DF) = 188, RMSEA (low,
high) = 0.04 (0.04, 0.05), CFI = 0.91, TLI = 0.91] and in bo h
boys [χ2= 514.36, DF = 188, RMSEA (low, high) = 0.06 (0.06,
0.07), CFI = 0.92, TLI = 0.91] and gi ls [χ2= 355.69, DF = 188,
RMSEA (low, high) = 0.05 (0.04, 0.05), CFI = 0.92, TLI = 0.91].
As shown in Table 2, all s anda dized pa ame e s we e posi i e
and signi ican (p<0.05) and g ea e han 0.40 excep o i em 6
(β= 0.39).
Reliabili y, as measu ed wi h C onbach α, was adequa e o
bo h PsyFlex (α= 0.80) and PsyIn lex (α= 0.77). Conside ing
ha α alues may unde es ima e he eal popula ion alue, we
calcula ed he CRI (G aham, 2006), which esul ed in eliabili y
alues o 0.83 o bo h PsyFlex and PsyIn lex.
Cons uc Validi y
C onbach α o he wo ac o s o he AFQ-Y was 0.82 o CF and
0.78 o EA. Resul s o he ou co ela ed ac o model we e good
[χ2= 1,001.93, DF = 622, RMSEA (low, high) = 0.03 (0.02,0.03),
CFI = 0.92, TLI = 0.92]. As expec ed, he wo ac o s o he
AFQ-Y showed mo e s ong and posi i e ela ions wi h PsyIn lex
( xy = 0.64 o CF; and xy = 0.57 o EA) han wi h PsyFlex
( xy = 0.30 o CF; and xy = 0.24 o EA).
P edic i e Validi y
We i s conduc ed CFA and eliabili y calcula ions o Pe D
and EmpCon subscales. The model showed adequa e i indices
[χ2= 342.22, DF = 76, RMSEA (low, high) = 0.06 (0.05, 0.07),
CFI = 0.94, TLI = 0.93]. C onbach αwas 0.70 o EmpCon and
0.67 o Pe D, and CRI was 0.86 o EmpCon and 0.78 o Pe D.
The pa h model showed good i indices [χ2= 55.71, DF = 16,
RMSEA (low, high) = 0.05 (0.04, 0.07), CFI = 0.97, TLI = 0.91].
Di ec E ec s
As shown in Table 3, all au o eg essi e pa ame e s we e
posi i e and signi ican , which showed he empo al s abili y
o he ou ac o s. Rega ding he p edic i e ela ion be ween
PsyFlex, PsyIn lex, and bo h Pe D and EmpCon, he esul s
showed ha , om Time 3 o Time 2, Pe D was posi i ely
ela ed o PsyIn lex (β= 0.15, p<0.05), and EmpCon
was posi i ely ela ed o PsyFlex (β= 0.11, p<0.05)
and nega i ely ela ed o PsyIn lex (β=−0.09, p<0.05).
Simila pa e ns o ela ions occu ed om Time 2 o Time
1 (Table 3). In e es ingly, while he ela ion be ween Pe D
and PsyIn lex was unidi ec ional, wi h PsyIn lex p edic ing
Pe D, he ela ion be ween EmpCon and PsyFlex was
bidi ec ional (Table 3). The explained a iance o he model
was 34% o EmpCon, 36% o Pe D, 30% o PsyFlex, and
26% o PsyIn lex.
Indi ec E ec s
The analyses con i med wo ou es leading o Pe D in Time
3: on he one hand, he PsyIn lex ou e, s a ing a Time 1
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Valdi ia-Salas e al. S igma izing Though s, Empa hy, and Dis ess
and going h ough Time 2, which yielded a posi i e ela ion
[β= 0.08, SE = 0.03 (s anda dized = 0.07; 0.02); p<0.01];
on he o he hand, he mixed ou e, s a ing wi h PsyFlex a
Time 1 and going h ough PsyIn lex a Time 2, which yielded
a nega i e ela ion o he occu ence o Pe D [β=−0.02;
SE = 0.006; (s anda dized = −0.02; 0.006) p<0.01]. In bo h
TABLE 1 | Desc ip i e analyses, co ela ions, a iances, and co a iances.
I ems* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1. 1.07 0.23** 0.19** 0.19** 0.10** 0.31** 0.33** 0.27** 0.30** 0.20** 0.17** 0.23** 0.22** 0.16** 0.23** 0.19** 0.09** 0.18** 0.24** 0.25** 0.15**
2. 0.31 1.61 0.29** 0.26** 0.30** 0.10** 0.21** 0.14** 0.19** 0.40** 0.26** 0.15** 0.12** 0.27** 0.13** 0.27** 0.36** 0.11** 0.29** 0.18** 0.15**
3. 0.27 0.50 1.92 0.15** 0.30** 0.08** 0.11** 0.04** 0.10** 0.34** 0.26** 0.14** 0.05 0.23** 0.16** 0.16** 0.30** 0.08*0.29** 0.10** 0.05
4. 0.27 0.46 0.30 1.97 0.37** 0.15** 0.33** 0.13** 0.30** 0.22** 0.20** 0.13** 0.09*0.16** 0.16** 0.14** 0.21** 0.08** 0.27** 0.24** 0.14**
5. 0.15 0.53 0.58 0.72 1.98 0.01 0.18** −0.03** 0.09** 0.38** 0.27** 0.08*−0.00 0.29** 0.08*0.19** 0.36** 0.04 0.27** 0.17** 0.03
6. 0.33 0.13 0.11 0.21 0.01 1.08 0.30** 0.30** 0.32** 0.10** 0.08*0.20** 0.37** 0.17** 0.26** 0.11** 0.02 0.25** 0.09** 0.17** 0.19**
7. 0.37 0.30 0.17 0.50 0.27 0.34 1.20 0.23** 0.44** 0.20** 0.19** 0.22** 0.26** 0.18** 0.27** 0.15** 0.15** 0.21** 0.23** 0.25** 0.15**
8. 0.29 0.18 0.05 0.18 −0.04 0.32 0.26 1.04 0.38** 0.11** 0.07 0.21** 0.21** 0.07*0.30** 0.16** 0.02 0.26** 0.12** 0.17** 0.19**
9. 0.35 0.28 0.16 0.47 0.15 0.38 0.55 0.44 1.28 0.18** 0.14** 0.22** 0.27** 0.20** 0.30** 0.21** 0.12** 0.29** 0.29** 0.17** 0.20**
10. 0.28 0.68 0.63 0.42 0.72 0.13 0.30 0.16 0.27 1.81 0.33** 0.18** 0.06 0.38** 0.19** 0.29** 0.52** 0.15** 0.40** 0.24** 0.17**
11. 0.24 0.46 0.50 0.38 0.53 0.11 0.29 0.09 0.22 0.62 1.91 0.19** 0.07∗0.25** 0.20** 0.18** 0.31** 0.08*0.38** 0.24** 0.16**
12. 0.29 0.24 0.24 0.22 0.15 0.25 0.30 0.27 0.31 0.30 0.33 1.54 0.24** 0.21** 0.27** 0.15** 0.12** 0.29** 0.27** 0.21** 0.14**
13. 0.22 0.14 0.07 0.12 −0.00 0.36 0.27 0.21 0.28 0.07 0.10 0.28 0.90 0.19** 0.28** 0.14** 0.05 0.23** 0.08*0.17** 0.17**
14. 0.23 0.46 0.43 0.30 0.55 0.24 0.26 0.10 0.30 0.69 0.47 0.36 0.24 1.80 0.30** 0.29** 0.37** 0.16** 0.34** 0.19** 0.18**
15. 0.26 0.18 0.25 0.25 0.12 0.30 0.33 0.34 0.38 0.28 0.31 0.37 0.29 0.45 1.23 0.23** 0.22** 0.29** 0.23** 0.24** 0.29**
16. 0.25 0.44 0.29 0.27 0.36 0.14 0.22 0.22 0.31 0.51 0.32 0.24 0.17 0.50 0.33 1.72 0.32** 0.23** 0.29** 0.27** 0.20**
17. 0.13 0.61 0.55 0.39 0.67 0.03 0.21 0.03 0.18 0.93 0.58 0.20 0.06 0.66 0.33 0.56 1.78 0.16** 0.46** 0.24** 0.18**
18. 0.22 0.17 0.14 0.13 0.07 0.30 0.27 0.32 0.38 0.24 0.14 0.43 0.26 0.26 0.39 0.36 0.25 1.43 0.22** 0.21** 0.23**
19. 0.33 0.50 0.54 0.53 0.53 0.13 0.35 0.17 0.45 0.74 0.72 0.45 0.10 0.62 0.36 0.53 0.83 0.35 1.87 0.29** 0.25**
20. 0.32 29 0.17 0.42 0.29 0.22 0.33 0.22 0.24 0.40 0.42 0.33 0.20 0.32 0.34 0.44 0.40 0.31 0.50 1.54 0.31**
21. 0.17 0.21 0.07 0.21 0.05 0.21 0.18 0.21 0.24 0.25 0.25 0.20 0.18 0.28 0.35 0.29 0.28 0.30 0.38 0.42 1.23
Mean: 1.91 3.06 2.57 2.48 2.85 1.76 1.96 1.64 1.92 2.93 2.72 2.20 1.62 5.56 1.93 2.47 2.80 2.03 2.80 2.25 2.04
SD: 1.03 1.27 1.38 1.40 1.41 1.04 1.10 1.02 1.13 1.34 1.38 1.24 0.95 1.34 1.11 1.31 1.33 1.20 1.37 1.24 1.11
Skewness: 1.13 −0.06 0.43 0.49 0.14 1.37 1.06 1.69 1.15 0.05 0.31 0.77 1.65 0.45 1.15 0.56 0.18 1.00 0.21 0.75 0.95
Ku osis: 0.84 −0.99 −1.09 −1.07 −1.26 1.21 0.48 2.27 0.49 −1.15 −1.13 −0.46 2.34 −0.95 0.61 −0.78 −1.12 0.04 −1.16 −0.44 0.23
SD, S anda d De ia ion. *p <0.05. **p <0.01.
∗I ems (Spanish adap a ion)
1. My biases and p ejudices a ec how I in e ac wi h people om di e en backg ounds (Mis p ejuicios in luyen en mi mane a de elaciona me con pe sonas que son
di e en es a mí).
2. I eel ha I am awa e o my own biases (Sien o que soy conscien e de mis p opios p ejuicios).
3. My nega i e hough s abou o he s a e ne e a p oblem in my li e (Mis pensamien os nega i os sob e o as pe sonas no me gene an p oblemas en mi ida).
4. I need o educe my nega i e hough s abou o he s in o de o ha e good social in e ac ions (Necesi o educi los pensamien os nega i os hacia los demás pa a pode
ene buenas elaciones con ellos).
5. When I e alua e someone nega i ely, I am able o ecognize ha his is jus a eac ion, no an objec i e ac (Cuando pienso mal sob e alguien, soy capaz de econoce
que es o es solo lo que yo pienso, y no necesa iamen e algo eal sob e esa pe sona).
6. I s op doing hings ha a e impo an o me when i in ol es someone I don’ like (Dejo de hace las cosas que son impo an es pa a mí cuando pa icipa alguien que
no me gus a).
7. I ha e ouble le ing go o my judgmen s o o he s (Me esul a di ícil consegui que mis juicios sob e los demás no me in luyan).
8. I eel ha my p ejudicial hough s a e a signi ican ba ie o me being cul u ally sensi i e (Sien o que mis p ejuicios me di icul an espe a a pe sonas de o as cul u as).
9. I ha e ouble no ac ing on my nega i e hough s abou o he s (Me esul a complicado que mis pensamien os nega i os sob e los demás no me in luyan en cómo
ac úo).
10. I’m good a no icing when I ha e a judgmen o ano he pe son (Cuando hago juicios sob e o as pe sonas, me doy cuen a de que los es oy haciendo).
11. I ’s OK o ha e iends ha I ha e nega i e hough s abou om ime o ime (No pasa nada po ene amigos sob e los que a eces engo pensamien os nega i os).
12. I don’ s uggle wi h con olling my e alua ions abou o he s (No me es ue zo po e i a hace alo aciones sob e los demás).
13. When I am ha ing nega i e hough s abou o he s, I wi hd aw om people (Cuando engo pensamien os nega i os sob e o as pe sonas, me aislo de la gen e).
14. When I’m alking wi h someone I don’ like, I’m awa e o my e alua ions o hem (Cuando es oy hablando con alguien que no me gus a, me doy cuen a de las
alo aciones nega i as que hago de esa pe sona).
15. When I ha e judgmen s abou o he s, hey a e e y in ense (Cuando juzgo a los demás, suelo hace lo de mane a muy in ensa).
16. When alking wi h someone I belie e should ac acco ding o how I eel abou him/he , e en i i is nega i e (C eo que cuando hablo con una pe sona, yo debe ía
ac ua de acue do a lo que sien o po ella, incluso cuando lo que sien o es nega i o).
17. I am awa e when judgmen s abou o he s a e passing h ough my mind (Se me da bien da me cuen a cuando hago juicios sob e o as pe sonas).
18. I a ely wo y abou ge ing my e alua ions owa d o he s unde con ol (No me p eocupo po man ene bajo con ol mis alo aciones nega i as sob e los demás).
19. I accep ha I will some imes ha e unpleasan hough s abou o he people (Acep o que a eces end é pensamien os desag adables sob e los demás).
20. I o en ge caugh up in my e alua ions o wha o he s a e doing w ong (A menudo me quedo pillado dándole uel as a las alo aciones que hago sob e lo que o os
hacen mal).
21. The bad hings I hink abou o he s mus be ue (Deben de se e dad las cosas malas que pienso de los demás).
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Valdi ia-Salas e al. S igma izing Though s, Empa hy, and Dis ess
TABLE 2 | Es ima ed pa ame e s in he con i ma o y ac o analysis.
I em Es ima e SE S anda dized
es ima e
S anda dized
SE
In lex by T1PRE_1 1.000 0.000 0.605 0.014
T1PRE_4 0.876 0.056 0.530 0.026
T1PRE_6 0.638 0.028 0.386 0.021
T1PRE_7 1.101 0.060 0.666 0.028
T1PRE_8 0.795 0.090 0.481 0.046
T1PRE_9 1.085 0.059 0.657 0.021
T1PRE_13 0.680 0.020 0.412 0.009
T1PRE_15 1.090 0.054 0.660 0.020
T1PRE_16 1.091 0.063 0.660 0.032
T1PRE_20 0.926 0.032 0.560 0.011
T1PRE_21 0.905 0.068 0.548 0.030
Flex by T1PRE_2 1.000 0.000 0.531 0.015
T1PRE_3 0.900 0.079 0.478 0.030
T1PRE_5 0.976 0.039 0.518 0.013
T1PRE_10 1.393 0.064 0.739 0.028
T1PRE_11 0.967 0.046 0.514 0.020
T1PRE_12 0.947 0.026 0.503 0.006
T1PRE_14 1.113 0.068 0.591 0.021
T1PRE_17 1.300 0.059 0.690 0.021
T1PRE_18 0.774 0.028 0.411 0.020
T1PRE_19 1.342 0.044 0.713 0.018
Flex wi h in lex 0.224 0.007 0.697 0.008
All pa ame e s we e signi ican wi h p <0.01.
cases, PsyIn lex played a signi ican media ing ole. Rega ding
he occu ence o EmpCon a Time 3, analyses con i med h ee
ou es: i s , he PsyIn lex ou e, s a ing a Time 1 and going
h ough Time 2, which yielded a nega i e ela ion [β=−0.05;
SE = 0.001; (s anda dized = −0.04; 0.004); p<0.01]; he
second ou e s a ed wi h PsyFlex a Time 1 and con inued
wi h EmpCon a Time 2, wi h posi i e e ec on EmpCon a
Time 3 [β= 0.06; SE = 0.004; (s anda dized = 0.06;0.008);
p<0.01]; las ly, he PsyFlex ou e, which also had a posi i e
e ec on EmpCon a Time 3 and had PsyFlex as p edic i e
a iable a bo h Times 1 and 2 [β= 0.04; SE = 0.004;
(s anda dized = −0.04; 0.01); p<0.01]. These EmpCon
ou es indica e he media ing ole o PsyFlex, al hough in
his case, PsyFlex and EmpCon seem o show a non- ecu si e
pa e n o in luence.
DISCUSSION
The pu pose o he cu en esea ch was o conduc a alidi y
s udy o a Spanish e sion o he AAQ-S wi h a sample o
adolescen s aged 11–17 yea s. S a is ical analyses con i med
a wo-co ela ed- ac o solu ion (PsyFlex and PsyIn lex), he
adequa e eliabili y o bo h ac o s and hei cons uc and
p edic i e alidi y in he expec ed di ec ion.
The CRI yielded he same eliabili y o bo h PsyFlex and
PsyIn lex, a alue simila o ha shown in he ini ial alida ion
o he ins umen (Le in e al., 2014). S ill, he PsyIn lex
subscale showed only adequa e α alue, and he pe cen age
TABLE 3 | Es ima ed pa ame e s in he longi udinal pa h model.
Va iables Es ima e SE S anda dized
es ima es
SE p
Pe DT3 ON Pe DT2 0.513 0.047 0.551 0.076 0.000
EmpConT2 −0.059 0.043 −0.063 0.051 0.213
PsyFlexT2 0.041 0.030 0.047 0.038 0.225
PsyIn lexT2 0.156 0.045 0.147 0.033 0.000
EmpConT3 ON Pe DT2 0.179 0.083 0.171 0.092 0.064
EmpConT2 0.456 0.056 0.433 0.006 0.000
PsyFlexT2 0.110 0.001 0.112 0.012 0.000
PsyIn lexT2 −0.105 0.004 −0.088 0.011 0.000
PsyFlexT3 ON Pe DT2 −0.066 0.052 −0.062 0.048 0.194
EmpConT2 0.222 0.085 0.206 0.089 0.020
PsyFlexT2 0.494 0.036 0.493 0.013 0.000
PsyIn lexT2 −0.097 0.099 −0.079 0.084 0.342
PsyIn lexT3 ON Pe DT2 0.011 0.066 0.014 0.080 0.865
EmpConT2 0.036 0.027 0.043 0.037 0.247
PsyFlexT2 −0.007 0.017 −0.008 0.023 0.713
PsyIn lexT2 0.479 0.111 0.501 0.064 0.000
Pe DT2 ON Pe DT1 0.490 0.051 0.470 0.048 0.000
EmpConT1 0.093 0.040 0.091 0.038 0.015
PsyFlexT1 0.023 0.045 0.024 0.047 0.603
PsyIn lexT1 0.083 0.039 0.069 0.036 0.053
EmpConT2 ON Pe DT1 0.048 0.045 0.046 0.044 0.294
EmpConT1 0.478 0.018 0.472 0.015 0.000
PsyFlexT1 0.134 0.023 0.141 0.020 0.000
PsyIn lexT1 −0.037 0.078 −0.031 0.065 0.633
PsyFlexT2 ON Pe DT1 0.033 0.035 0.030 0.031 0.338
EmpConT1 0.092 0.009 0.085 0.008 0.000
PsyFlexT1 0.373 0.020 0.366 0.013 0.000
PsyIn lexT1 0.038 0.072 0.030 0.057 0.603
PsyIn lexT2 ON Pe DT1 0.068 0.030 0.074 0.033 0.025
EmpConT1 0.028 0.041 0.031 0.046 0.491
PsyFlexT1 −0.131 0.008 −0.156 0.012 0.000
PsyIn lexT1 0.503 0.016 0.478 0.014 0.000
Pe D, pe sonal dis ess; EmpCon, empha ic conce n; PsyFlex, psychological
lexibili y; PsyIn lex, psychological in lexibili y; T1, Time 1; T2, Time 2; T3,
Time 3.
o explained a iance o he p edic i e model was lowe han
ha o PsyFlex. This may be he esul o he wo ding o
he PsyIn lex i ems ha may ha e been di icul o ea ly
adolescen s (in ou sample, a e age age was 13.66 yea s; age
ange, 11–17 yea s). In ac , in he s udy by T igue os e al.
(2020), which employed an olde sample (a e age age was
17.12 yea s; age ange, 15–19 yea s), eliabili y o he PsyIn lex
subscale was highe . Should his ins umen be u he adap ed
o ea ly adolescence, ewo ding o he PsyIn lex i ems is highly
ecommended (G eco e al., 2008).
Mos i ems loaded on o hei co esponding ac o , bu we
also ound unexpec ed co ela ions among di e en - ac o i ems.
Again, we a gue ha he adap a ion o his ins umen o
ea ly adolescen s equi e u he e inemen in he wo ding
o he i ems so as o clea ly di e en ia e be ween lexible
and in lexible eac ions o s igma izing hough s. Fo ins ance,
PsyFlex i em 17 eads: “I am good a no icing when I
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Valdi ia-Salas e al. S igma izing Though s, Empa hy, and Dis ess
ha e a judgmen o ano he pe son,” and PsyIn lex i em 16
eads: “When alking wi h someone, I belie e I should ac
acco ding o how I eel abou him/he , e en i i is nega i e.”
Howe e , i is compa ible being awa e o you s igma izing
hough s and s ill ac ing on hem. Un o una ely, in he
o iginal alida ion o he scale (Le in e al., 2014), PsyFlex
i ems we e e e se sco ed, so i is no possible o es ablish
compa isons wi h ou indings. Fu he e inemen s o he
ins umen adap ed o Spanish ea ly adolescen s ough o ake
his in o conside a ion.
The wo- ac o solu ion showed good i indices in he
o al sample and when sepa a ed by gende . This goes in
line wi h p e ious s udies ha ha e no ound di e ences
in PsyIn lex and PsyFlex wi h s igma izing hough s as a
unc ion o gende (T igue os e al., 2020). Rega dless o
how he s igma izing hough s a e acqui ed and how hei
con en may be di e en as a ma e o gende , ou esul s
sugges ha bo h gende s ela e o such hough s bo h in
lexible and in lexible ways. This p obably ela es o he ac
ha PsyIn lex and PsyFlex a e gene al o e a ching egula o y
skills ha , once lea ned, occu wi h hough s and eelings
ha a e expe ienced as a e si e ega dless o hei con en
(Mones ès e al., 2018). The cons uc alidi y s udy showed
ha he in lexibili y ac o s o he AFQ-Y, namely, CF
and EA, we e mo e s ongly ela ed o PsyIn lex han o
PsyFlex, as expec ed.
The p edic i e alidi y s udy yielded he mos in e es ing
esul s. As expec ed, di ec e ec s showed ha PsyIn lex
p edic ed he occu ence o Pe D and p e en ed he occu ence
o EmpCon, and PsyFlex p edic ed he occu ence o EmpCon.
PsyIn lex wi h s igma izing hough s leads o Pe D and blocks
he expe ience o empa hy in he s igma ize . In e es ingly, while
he ela ion be ween PsyIn lex and Pe D seems unidi ec ional,
wi h PsyIn lex p edic ing Pe D, he ela ion be ween PsyFlex
and EmpCon seems bidi ec ional. Tha is, ela ing wi h
lexibili y o ou s igma izing hough s abou o he s makes
us mo e empa he ic, and in u n, p ac icing he empa he ic
conce n o o he s’ si ua ion makes us mo e empa he ic
and mo e psychologically lexible wi h ou s igma izing
hough s, in a kind o upwa d i uous cycle. The bidi ec ional
ela ion be ween psychological in/ lexibili y and ou come
a iables has been epo ed be o e (Valdi ia-Salas e al.,
2017) and shows i s suscep ibili y o aining and change
o e ime. This is especially ele an du ing adolescence,
when egula o y skills a e no ye ully consolida ed, and
hence p e en ion and socioeduca i e in e en ions a e c ucial
(Glick and Hil , 2000).
In he same line, he indi ec e ec s showed expec ed esul s
such as he p edic i e ole o PsyIn lex o he de elopmen o
Pe D and he p edic i e ole o PsyFlex o he de elopmen
o EmpCon. This sugges s ha , when main ained o e ime as
he p edominan coping s a egy, PsyIn lex will lead o Pe D,
whe eas PsyFlex will lead o EmpCon. Indi ec e ec also showed
he p o ec i e e ec s o PsyFlex o he de elopmen o Pe D
in ha high PsyIn lex sco es a Time 2 led o ei he Pe D
o EmpCon, depending on he beha io egula ion skills a
Time 1: when adolescen s sco ed high in PsyFlex a Time 1,
he mos p obable ou come a Time 3 was EmpCon, whe eas
when adolescen s sco ed high in PsyIn lex a Time 1, he mos
p obable ou come a Time 3 was Pe D. Somehow, depa ing
om lexible egula o y skills bu e ed he nega i e consequences
o de eloping in lexible egula o y skills a some ime du ing
de elopmen . This has g ea implica ions o he p omo ion
o PsyFlex as ea ly as possible du ing childhood. And calls
o u he esea ch on he ole exe ed by PsyFlex in he
in e play among Pe D, EmpCon, and pe spec i e- aking, one o
he componen s o cogni i e empa hy, which seems o deac i a e
Pe D in a o o EmpCon (G aziano and Habashi, 2010;Habashi
e al., 2016). I migh be he case ha PsyFlex, which in ol es
pe spec i e om ou own hough s (Le in e al., 2014), somehow
acili a ed aking ano he ’s pe spec i e and led o EmpCon
a he han Pe D.
These indings con i m he impo ance o conside ing he
ole o egula o y skills in he expe ience o ei he EmpCon
o Pe D when in he p esence o s igma izing hough s abou
o he s (Dece y and Jackson, 2004). And also, hese indings go
in line wi h he e idence ha ac ing on hough s and eelings
o somehow al e hei con en o alle ia e hei p esence (i.e.,
PsyIn lex) leads o in e nalizing and ex e nalizing p oblems, also
du ing adolescence. As e iewed in he in oduc o y sec ion,
Pe D is ega ded as a sel - ocus a e si e–a ec i e eac ion o
ano he ’s emo ion ha is associa ed wi h he desi e o alle ia e
one’s own, bu no he o he ’s dis ess (e.g., Eisenbe g e al.,
2010;Win e e al., 2017). Ou indings p o e ha Pe D
de i es om iden i ying wi h s igma izing hough s and ac ing
on hem (o “pushed” by hem) despi e he mid- and long-
e m consequences his may ha e in bo h he s igma ize and
he s igma ized.
Ou s udy demons a es ha beha io egula ion skills
in luence he deg ee o which an adolescen will expe ience
mo e EmpCon o mo e Pe D when hey wi ness a nega i e
expe ience o o he s. Bu we canno asse ha PsyFlex
and PsyIn lex will in luence hei engagemen in ei he
p osocial o agg essi e beha io . P e ious li e a u e would
suppo his hypo hesis (see, o ins ance, Masuda e al.,
2007, 2009); s ill u he esea ch is called o . Fu he
esea ch should also include la ge samples so as o inc ease
he gene alizabili y o ou indings, addi ional wa es ha
allowed analyzing wi hin-subjec and be ween-subjec e ec s,
and expe imen al designs.
In Spain, p ejudices and s igma become e iden in he
beha io o adolescen s om he ea ly age o 12 yea s (e.g.,
Fe agu e al., 2017). Ou s udy shows ha he way he
adolescen s eac o hei s igma izing hough s may be one ea ly
link o he chain o ei he p osocial o agg essi e/disc imina o y
beha io .
DATA AVAILABILITY STATEMENT
The aw da a suppo ing he conclusions o his a icle
will be made a ailable by he au ho s, wi hou undue
ese a ion.
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psyg-11-565638 Janua y 18, 2021 Time: 17:36 # 8
Valdi ia-Salas e al. S igma izing Though s, Empa hy, and Dis ess
ETHICS STATEMENT
The s udies in ol ing human pa icipan s we e e iewed and
app o ed by Comi é é ico de in es igación clínica de A agón.
W i en in o med consen o pa icipa e in his s udy was
p o ided by he pa icipan s’ legal gua dian/nex o kin.
AUTHOR CONTRIBUTIONS
SV-S and JM-A designed he s udy. VV-B managed da a
collec ion and da abase upda e. AC assis ed du ing da a
collec ion. JM-A conduc ed da a analyses. SV-S, JM-A, and
AC w o e he manusc ip . VV-B and TJ e ised p e ious
e sions o he manusc ip . All au ho s ead and app o ed he
submi ed e sion.
FUNDING
This esea ch was pa ially suppo ed by g an s
om Uni e si y o Za agoza and Ibe caja Founda ion
( e . JIUZ-2016-SOC-04) and om Go e nmen o
A agon and FEDER Building Eu ope om A agon
( e . LMP40_18).
ACKNOWLEDGMENTS
We hank he p incipals o he pa icipa ing high schools
as well as he s a membe s who collabo a ed wi h he
esea ch eam du ing da a collec ion. As well, we hank he
amilies who ga e hei in o med consen o hei child en o
pa icipa e in he s udy.
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Con lic o In e es : The au ho s decla e ha he esea ch was conduc ed in he
absence o any comme cial o inancial ela ionships ha could be cons ued as a
po en ial con lic o in e es .
Copy igh © 2021 Valdi ia-Salas, Ma ín-Albo, C uz, Villanue a-Blasco and
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